INTIMATE PARTNER VIOLENCE AGAINST WOMEN IN THE …

Violence against women has been recognized as an important public health and human rights problem, both globally1 and within the Americas2. The World Health Organization (WHO) estimates that 30% of women in the Americas have experienced physical and/or sexual violence by a partner, while 11% have experienced sexual violence by a non-partner.3

Intimate partner violence (IPV) – the most common form of violence against women – has serious consequences for women’s health and wellbeing.3 A 12-country analysis from the Latin American and Caribbean region4 found that large proportions of women who experienced IPV reported physical and mental health consequences, including physical injuries, chronic pain, anxiety, depression, and suicidal thoughts. In most countries, IPV was significantly correlated with lower age at first union, higher parity, and unintended pregnancy. IPV also has well documented negative consequences for children and the broader society.5,6

In 2015, United Nations (UN) Member States agreed to work towards eliminating violence against women as part of 2030 Sustainable Development Goals (SDG).7 Member States of the Pan American Health Organization (PAHO) and the World Health Organization (WHO) made similar commitments as part of PAHO’s 2015 Strategy and Plan of Action on Violence against Women8 and WHO’s 2016 Global Plan of Action on interpersonal violence, in particular violence against women and girls and violence against children.9 Strengthening data collection systems and measures is a key commitment made in all of these agreements and a priority for PAHO.

Violence against women is a human rights violation and a public health problem.

INTIMATE PARTNER VIOLENCE

AGAINST WOMEN IN THE AMERICAS:

DATA AND ACTION

SDG Target 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitationSDG Indicator 5.2.1: The proportion of ever-partnered women and girls aged 15+ years subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months.

An estimated 1 in 3 ever-partnered women aged 15–49 in the Americas have experienced physical and/or sexual violence by a partner.www.paho.org/violence

Bott S, Guedes A, Ruiz-Celis AP, Mendoza JA. Intimate partner violence in the Americas: a systematic review and reanalysis of national prevalence estimates. Rev Panam Salud Publica. 2019;43:e26. https://doi.org/10.26633/RPSP.2019.26

Intimate partner violence in the Americas: A systematic review and reanalysis of national prevalence estimates and changes over timeObjectives: To describe what is known about the prevalence of intimate partner violence against women in the Americas across countries and over time, including geographic coverage, quality, and comparability of data.

Methods: A systematic review of national, population-based estimates of IPV against women from any PAHO Member State in the Americas from 1998 to 2017 was carried out by searching the indexed journal literature, international and governmental databases; hand-searching existing reviews; and contacting researchers and governments throughout the Region. Eligible surveys had to provide adequate information about methods and measures and meet basic quality criteria. Estimates from the most recent eligible national surveys in each country were reanalyzed for cross-country comparability (by PAHO), received directly from the original research teams or extracted from reports, including IPV prevalence by type (physical; sexual; physical and/or sexual), timeframe (ever; past year), and perpetrator (any partner in life; current/most recent partner). In

Demographic Health Surveys (DHS) Colombia (2015), Dominican Republic (2013), Guatemala (2014-15),Haiti (2016-17), Honduras (2011),Nicaragua (2011-12),Panama (2009), Peru (2017), Venezuela (2010)

Reproductive Health Surveys (RHS) Paraguay (2008)

World Health Organization, Multi-Country Study (WHO MCS)Belize (2015),El Salvador (2013-14),Jamaica (2016),Trinidad and Tobago (2017)

International Violence Against Women Survey (IVAWS)Argentina (2015),Costa Rica (2003)

Encuesta Nacional sobre la Dinámica de las Relaciones en los Hogares (ENDIREH) or similarBolivia (2016), Ecuador (2011), El Salvador (2017),Mexico (2016), Uruguay (2013)

Unique surveysBrazil (2017), Canada (2014), Chile (2016-17), USA (2010-12)

countries with 3+ rounds of data, Cochran-Armitage and Pearson chi square tests were used to assess whether changes over time were significant (p<0.05).

Results: Twenty four countries in the Americas had eligible estimates, and four more had potentially eligible national surveys in development (Cuba, Grenada, Guyana, and Suriname). Reported prevalence of physical and/or sexual IPV ever ranged from about one in seven (14-17%) ever-partnered women aged 15-49 (unless noted in page 5) in Brazil, Panama, and Uruguay, to more than half (58.5%) in Bolivia. Past year prevalence of physical and/or sexual IPV ranged from 1% in Canada to more than one-fourth (27.1%) in Bolivia. Significant declines in reported prevalence of certain types of IPV were documented in eight countries; however, some changes were small, some indicators did not change significantly, and significant increases were found in the reported prevalence of physical IPV (past year) in the Dominican Republic.

Conclusions: Intimate partner violence against women remains a public health and human rights problem across the Americas, suggesting a need for greater and more sustained investment in evidence-based initiatives to prevent and respond to such violence and for more comparable, high quality data for monitoring the impact of these efforts.

*

*

For reasons explained in the text, two surveys implemented in El Salvador were included in the analysis. The map shows the latest survey implemented.*

Percentage of women who reported physical and/or sexual IPV, ever and past 12 months

COUNTRY, YEAR

PA

RT

NE

R

PHYSICAL AND/OR SEXUAL

SEXUAL PHYSICALN

Ever Past year Ever Past year Ever Past year

Argentina 2015 Any 26.9 2.7 3.9 0.2 26.5 2.7 1 221

Belize 2015 Any 22.2 — 6.9 — 21.9 — 501

Bolivia 2016 CMR 58.5 27.1 34.6 16.3 52.4 21.4 4 149

Brazil 2017 Any 16.7 3.1 2.4 0.7 16.1 2.7 1 116

Canada 2014 Any — 1.1 — — — — [a]

CMR — 0.8 — — — —

Chile 2016/17 Any — — 6.7 2.1 — 2.7 6 824

Colombia 2015 CMR 33.3 18.3 7.6 3.8 32.3 17.5 24 862

Costa Rica 2003 Any 35.9 7.8 15.3 2.5 33.4 6.9 822

Dominican Republic 2013 Any 28.5 16.0 9.3 4.4 27.3 15.1 5 803

CMR 20.4 15.6 5.4 4.2 19.4 14.7

Ecuador 2011 Any 40.4 — 14.3 4.0 38.6 — 9 131

CMR 35.5 10.8 10.2 3.9 34.4 9.3

El Salvador 2017 CMR 14.3 5.9 5.0 2.0 13.7 5.4 2 127

El Salvador 2013/14 Any 24.7 6.7 11.9 3.2 20.6 4.9 741

CMR 15.7 — 7.7 — 12.0 —

Guatemala 2014/15 Any 21.2 8.5 7.1 2.6 20.4 7.9 6 512

CMR 18.0 8.5 5.2 2.6 17.3 7.9

Haiti 2016/17 Any 26.0 13.9 14.0 7.2 21.3 10.1 4 322

CMR 23.5 13.8 11.2 7.0 18.6 10.0

Honduras 2011/12 Any 27.8 11.0 10.9 3.3 25.9 10.0 12 494

CMR 21.6 10.9 6.5 3.2 20.2 10.0

Jamaica 2016 Any 28.1 8.6 7.6 2.4 25.6 7.1 723

Mexico 2016 Any 24.6 — 7.8 — 23.3 — 60 040

CMR 21.0 9.5 6.3 2.7 19.8 8.6

Nicaragua 2011/12 Any 22.5 7.5 10.1 3.5 20.0 6.1 12 065

Panama 2009 CMR 14.4 10.1 3.2 2.7 13.8 9.2 5 831

Paraguay 2008 Any 20.4 8.0 8.9 3.3 17.9 6.7 4 414

Peru 2017 CMR 31.2 10.6 6.5 2.4 30.6 10.0 21 454

Trinidad & Tobago 2017 Any 30.2 5.7 10.5 0.9 28.3 5.1 1 079

Uruguay 2013Any 16.8 3.1 6.6 0.6 15.7 2.9 1 560

CMR 7.6 2.8 2.4 0.6 7.0 2.6

USA 2010/12 Any 37.3 6.6 16.4 2.1 32.4 3.9 22 590

Venezuela 2010 CMR 17.9 12.2 4.7 3.3 17.5 11.7 [a]

[a] Unweighted denominators unavailable; full sample sizes of women: 17 966 (Canada); 3 793 (Venezuela). Notes: Any = Any partner in life; CMR = Current or most recent partner; — = unavailable.

PHYSICAL IPV EVER PHYSICAL IPV PAST YEAR

SEXUAL IPV PAST YEARSEXUAL IPV EVER

Physical ever

0

5

10

15

20

25

30

35

40

45

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT

Peru Nicaragua Mexico Haiti Dominican Republic Colombia

Physical Last Year

0

2

4

6

8

10

12

14

16

18

20

22

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT

Peru Nicaragua Mexico Haiti Guatemala Dominican Republic Colombia

Sexual Ever

0

2

4

6

8

10

12

14

16

18

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Sexual Last Year

0

2

4

6

8

10

12

14

16

18

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Made with

Physical ever

0

5

10

15

20

25

30

35

40

45

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Physical Last Year

0

2

4

6

8

10

12

14

16

18

20

22

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Sexual Ever

0

2

4

6

8

10

12

14

16

18

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Sexual Last Year

0

2

4

6

8

10

12

14

16

18

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Made with

Physical ever

0

5

10

15

20

25

30

35

40

45

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Physical Last Year

0

2

4

6

8

10

12

14

16

18

20

22

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Sexual Ever

0

2

4

6

8

10

12

14

16

18

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Sexual Last Year

0

2

4

6

8

10

12

14

16

18

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Made with

Physical ever

0

5

10

15

20

25

30

35

40

45

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Physical Last Year

0

2

4

6

8

10

12

14

16

18

20

22

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Sexual Ever

0

2

4

6

8

10

12

14

16

18

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Sexual Last Year

0

2

4

6

8

10

12

14

16

18

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

PERC

ENT


Made with

Percentage of ever partnered[a] women aged 15-49

who reported physical IPV and sexual IPV, ever and past 12 months, in national, population-based surveys from the Americas with 3+ round of comparable data collection, by type of violence, country and year

COLOMBIA

DOMINICAN REPUBLIC

GUATEMALA

HAITI

MEXICO

NICARAGUA

PERU

Notes: [a] Past year IPV estimates for Guatemala and Mexico were limited to women currently married or cohabiting at the time of the interview. [b] Estimates of sexual IPV from Guatemala and Nicaragua were limited to forced sex and excluded sex out of fear, because that item was not measured in one of the three surveys from each country. [c] Three data points for IPV ever were not available for Guatemala; [d] Colombia 2000 and Peru 2000 did not measure IPV past year; Peru 2000 did not measure sexual IPV.

COLOMBIA

COLOMBIAd

COLOMBIAd

COLOMBIA

GUATEMALAa,b

GUATEMALAa

MEXICOa

MEXICOa

MEXICO

MEXICO

NICARAGUAb

NICARAGUAb

NICARAGUA

NICARAGUA

PERUd

PERUd

PERUd

PERU

DOMINICAN REPUBLIC

DOMINICAN REPUBLIC

DOMINICAN REPUBLIC

DOMINICAN REPUBLIC

HAITI

HAITI

HAITI

HAITI

These charts present a preliminary analysis of changes over time in the reported prevalence of physical IPV and sexual IPV (ever and past 12 months) in seven countries with 3+ rounds of comparable data collection over 10-20 years. Physical and sexual IPV were analyzed separately, in case they changed in different directions or at different rates.

Changes in past year prevalence may reflect recent changes in levels of violence, while changes in lifetime prevalence of IPV may reflect longer term changes, including different life experiences of young women of reproductive age compared with older cohorts of women aging out of samples.

The reported prevalence of both physical and sexual IPV declined significantly (per Cochran-Armitage chi square trend testing) in all countries, except for physical IPV in the Dominican Republic (which rose significantly); sexual IPV in the past year in the Dominican Republic (which did not change); and physical IPV ever in Haiti (which rose significantly per Cochran-Armitage but not Pearson chi square test).

Given the limited number of data points for most countries and the fact that in some countries, prevalence rose before it fell (or vice versa), these findings should be considered preliminary, and they suggest a need for monitoring over a longer period of time and across age groups.

Sources and characteristics of IPV estimates from the Americas cited in this infographic

Country Survey name Data collection year Instrument Dedicated /module

Method Age (if not 15-49)

Partnership history (if not ever married/ cohabited)

Source (most recent)

Argentina Estudio sobre Violencia de Género 2015 IVAWS Dedicated Telephone 18-69 All women Report

Belize Belize Public Health Survey 2015 WHO Dedicated Household 18-64 Ever had romantic partner Report

Bolivia Encuesta de Prevalencia y Características de la Violencia contra las Mujeres

2016 Similar to ENDIREH Dedicated Household Reanalysis

Brazil Violência Doméstica e Familiar contra a Mulher, Pesquisa DataSenado

2017 Dedicated Telephone 16+ All women Research team

Canada General Social Survey 2004, 2009, 2014 Dedicated Mixed 15+ Married, cohabited, in contact w/ ex, past 5 yrs

Report

Chile Encuesta Nacional de Victimización por Violencia Intrafamiliar y Delitos Sexuales

2016/17 Dedicated Household 15-65 All women/currently had romantic partner

Report

Colombia Encuesta Nacional de Demografía y Salud 2000, 2005, 2010, 2015

DHS Module Household Reanalysis

Costa Rica International Violence Against Women Survey 2003 IVAWS Dedicated Household 18-69 Ever had romantic partner Research team

Dominican Republic

Encuesta Demográfica y de Salud 2002, 2007, 2013 DHS Module Household Reanalysis

Ecuador Encuesta Nacional de Relaciones Familiares y Violencia de Género contra las Mujeres

2011 Similar to ENDIREH Dedicated Household Reanalysis

El Salvador Encuesta Nacional de Violencia Contra las Mujeres

2017 Similar to ENDIREH Dedicated Household Ever had romantic partner Reanalysis

El Salvador Estudio de Población de Violencia contra las Mujeres

2014 WHO Dedicated Household Reanalysis

Guatemala Encuesta Nacional de Salud Materno Infantil 2002, 2008/9, 2014/5 RHS/DHS Module Household Reanalysis

Haiti Enquête Mortalité, Morbidité et Utilisation des Services

2000, 2005/6, 2012, 2016/17


Honduras Encuesta Nacional de Demografía y Salud 2011 DHS Module Household Reanalysis

Jamaica Women’s Health Survey 2016 WHO Dedicated Household Ever married, cohabited, had ‘regular’ (visiting) partner

Research team

Mexico Encuesta Nacional sobre la Dinámica de las Relaciones en los Hogares

2003, 2006, 2011, 2016 ENDIREH Dedicated Household Reanalysis

Nicaragua Encuesta de Demografía y Salud 1998, 2006/7, 2011/12 RHS/DHS Module Household Reanalysis

Panama Encuesta Nacional de Salud Sexual y Reproductiva

2009 DHS Module Household Report

Paraguay Encuesta Nacional de Demografía y salud Sexual y Reproductiva

2008 RHS Module Household 15-44 Reanalysis

Peru Encuesta Demográfica y de Salud Familiar 2000, 2004/6, 2007/8, 2009-17


Trinidad & Tobago

Trinidad and Tobago Women's Health Survey 2017 WHO Dedicated Household 15-64 Ever had romantic partner Report

Uruguay Encuesta Nacional de Prevalencia sobre Violencia Basada en Género y Generaciones

2013 Similar to ENDIREH Dedicated Household Male or female partner Reanalysis

USA National Intimate Partner and Sexual Violence Survey

2010/12 Dedicated Telephone 18+ All women Report

Venezuela Encuesta Demográfica 2010 DHS Module Household Report

Policy makers, health sector organizations, researchers and activists can help prevent and respond to violence against women by taking actions such as:

Collaborate across all sectors to mobilize comprehensive, evidence-based prevention and response efforts.

Collect and use data on prevalence, risk factors, consequences and contexts of violence against women to raise awareness, mobilize action and inform evidence-based programs and policies

Ensure a comprehensive service response to violence (including health, legal and social services) that identifies women exposed to violence, provides immediate care, mitigates harm, addresses long term effects of violence, and helps reduce reoccurrence.

Advocate for changes in policies that influence risk and protective factors for violence, including women’s and girls’ legal rights, access to education and economic empowerment

Change social norms that support or enable violence against women and children, and raise awareness of violence as a public health, human rights, and economic development problem.

Use a whole system approach to encourage all parts of the health system to recognize violence against women as a health issue.

A multi-sector response to violence is needed – one that includes health systems

REFERENCES1. United Nations General Assembly. Declaration on the Elimination of Violence Against Women. Geneva: United Nations; 1993. http://www.un.org/documents/ga/res/48/a48r104.htm Accessed July 2018.2. Organization of American States. Convención Interamericana para Prevenir, Castigar y Erradicar la Violencia contra la Mujer [Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women], “Convention of Belem Do Para”. Belém do Pará: General Assembly, Inter-American Commission on Human Rights, Organization of American States; 1994. http://www.oas.org/juridico/english/treaties/a-61.html Accessed July 2018.3. WHO. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization, Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council; 2013. http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/ Accessed July 2018.4. Bott S, Guedes A, Goodwin M, Mendoza JA. Violence against women in Latin America and the Caribbean: A comparative analysis of population-based data from 12 countries. Washington, DC: Pan American Health Organization; 2012. https://www.paho.org/hq/dmdocuments/2014/Violence1.24-WEB-25-febrero-2014.pdf Accessed July 2018.5. UN. Ending violence against women: From words to action. In-depth study on all forms of violence

against women. Report of the Secretary-General. New York: United Nations General Assembly; 2006. http://www.un.org/womenwatch/daw/vaw/v-sg-study.htm Accessed July 2018.6. Guedes A, Bott S, Garcia-Moreno C, Colombini M. Bridging the gaps: A global review of intersections of violence against women and violence against children. Global Health Action. 2016;9(31516).7. United Nations General Assembly. Transforming our world: The 2030 Agenda for Sustainable Development. Resolution adopted by the General Assembly on 25 September 2015. New York: United Nations General Assembly; 2015. http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E Accessed July 2018.8. PAHO. Strategy and plan of action on strengthening the health system to address violence against women, Resolution CD54.R12 of the 54th Directing Council. Washington, DC: Pan American Health Organization; 2015. http://iris.paho.org/xmlui/handle/123456789/28396 Accessed July 2018.9. WHO. Global plan of action to strengthen the role of the health system within a national multi-sectoral response to address interpersonal violence, in particular against women and girls, and against children. Geneva: World Health Organization; 2016. http://apps.who.int/iris/bitstream/10665/252276/1/9789241511537-eng.pdf?ua=1 Accessed July 2018.10. UN. Guidelines for producing statistics on violence against women. New York: United Nations, Department of Economic and Social Affairs Statistics Division; 2014. https://unstats.un.org/unsd/gender/docs/guidelines_statistics_vaw.pdf Accessed July 2018.

Key messages

• Population-based evidence from the Americas confirms that IPV against women remains a widespread public health and human rights problem in the Americas, with reported prevalence of physical and/or sexual IPV ever across countries ranging from about 14-17% to 58.5% women.

• While reported IPV prevalence declined in several countries, some changes were small, some indicators remained unchanged, and in two countries, reported prevalence rose over time.

• Intimate partner violence is preventable, but measurable changes in prevalence levels require continuity of policies and programs over a number of years.

• There is a need for greater and more sustained investment in evidence-based violence prevention and response.

• The evidence base has geographic gaps in coverage, and barriers to comparability.

• More research is needed to understand the impact of IPV across different age groups and among specific groups of women, including minority ethnic and racial populations, women with disabilities and older women, amongst others.

• Ideally countries would carry out high quality, national, population-based surveys every few years ensuring that these adhere to international scientific and ethical guidelines.10

• Well-designed population-based surveys can give countries evidence they need to develop policies and programs, monitor changes in the prevalence of violence against women over time and to measure progress towards the SDGs, as PAHO Member States have agreed to do.

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INTIMATE PARTNER VIOLENCE AGAINST WOMEN IN THE …